Ticket for Outdoor Patient
| Ward No. 17 | U-PHC No. | Registration No. 03066 | Date 17/09/2019 |
| Token No | SM/18-19/6594 21/09/2019 | Serial | 013 |
| Patient Name | Mrs. PRATIMA SRIMANI | Contact No | 9432168161 |
| Address | 24G BHAGIRATHI LANE | Age | 78 YRS Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||